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General NPI Number Information
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NPI Number | 1184665762
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Entity Type | Individual
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Provider Name | KRISTA LYNNE RANDALL-BLY LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1202 STATE ST
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City | ERIE
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State | PA
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Zip | 16501-1914
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Country | US
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Telephone | 814-455-7222
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Fax | 814-456-2375
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Provider Business Mailing Address
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Address Line | 1202 STATE ST
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City | ERIE
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State | PA
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Zip | 16501-1914
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Country | US
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Telephone | 814-454-4530
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Fax | 814-459-6678
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW007945L
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License Number State | PA
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